Lupus Site

FRIDAY, Jan. 10 (HealthScoutNews) -- A new way to
use a standard chemotherapy drug holds promise for re-booting the
immune system of those afflicted with lupus -- a disease in which
the body turns on itself.

That's the word from doctors at Johns Hopkins Medical Center, who
reported their successful treatment approach in today's issue of
Arthritis and Rheumatism.

According to researcher Dr. Michelle Petri, the treatment involves
blasting the body with extremely high doses of the chemotherapy
drug cyclophosphamide.

"The idea here is to essentially wipe out the immune system and
allow the body to reprogram itself to function normally," Petri
says.

In healthy people, the immune system's killer cells are called
into play only when a harmful bacteria or other cell-destroying
factor invades the body.

In lupus patients, however, the immune system goes awry, viewing
healthy cells as targets for destruction.

Doctors estimate that 500,000 to 1.5 million Americans are afflicted
with lupus, mostly women, with a high percentage in the black community.

"Despite treatment, in about half of all our lupus patients this
disease has claimed one or more organ systems," Petri says.

In the past, cyclophosphamide has been used in small doses over
a long period of time in hopes of slowly wiping out the renegade
immune cells. While the treatment was somewhat successful, the effects
were not long-lasting.

Other attempts at using high doses of cyclophosphamide have produced
less favorable results. Petri suspects that's because those trials
involved removing some of the patient's bone marrow before treatment,
and then replacing it afterward -- ostensibly to help the body rejuvenate
after the drug therapy.

"But we believe this simply reintroduced the bad immune cells back
into the body," Petri says.

In the new research, Petri and her colleagues found that because
cyclophosphamide does not affect stem cells, which help build new
bone marrow, there is no need for bone marrow removal or replacement.
This, she says, may be the secret to the treatment's success.

"The immune cells are destroyed but the stem cells remain and they
go to work rebuilding a new and hopefully normal immune system beginning
right after treatment," Petri says.

Dr. Robert Lahita, chief of rheumatology at St. Vincent's Medical
Center in New York City and chairman of the World Congress on Lupus
2004, says Petri's approach is a bit of a throwback to less sophisticated
times. Ironically, it could also be a step toward a lupus cure,
he adds.

"This idea of blasting cells with chemotherapy drugs is still an
old-fashioned way of treating disease, but it's the best thing we
have until we discover a major cure," Lahita says.

Even more important, he says, is that "it holds the potential for
many different diseases. The idea of re-booting the immune system
holds much promise in many different areas of treatment, which is
what makes this study particularly important and relevant."

The new research involved just 14 lupus patients, all with advanced
disease that had not responded to previous treatment. Each patient
received four days of high-dose cyclophosphamide treatment, followed
by close medical supervision for several weeks.

According to Petri, some of the patients developed fevers and infection
following treatment -- ostensibly because their immune system was
virtually not functioning -- and they required hospitalization for
antibiotic treatment.

However, after following the patients for up to 43 months, the
researchers found five of the 14 had a complete response, with no
signs of lupus activity in their body. Six other patients had a
partial response and were able to control their disease with the
use of several medications that had previously failed to work. The
treatment was considered to have failed in just three of the 14
patients.

"They may have had some pockets of cells hiding that the medication
simply could not reach, or their body may simply be programmed to
have lupus no matter what," Petri says.

While the treatment holds much promise, Lahita cautions that "it
should only be performed by extremely experienced rheumatologists
under strict laboratory conditions to ensure patient safety."

Further research on this treatment will be conducted at three medical
centers beginning almost immediately: Hanneman Hospital in Philadelphia,
the University of Wisconsin School of Medicine, and again at Johns
Hopkins School of Medicine.

Patients with advanced lupus who have not previously been treated
with cyclophosphamide may be eligible. For more information, call
the Lupus Center at 410-614-1573 or contact stdman@jhmi.edu